Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

KETAMINE 10 MG/ML INJECTION IV (CODE)

Facility

$70.20

Service Code	NDC 67457018120
Hospital Charge Code	163727
Hospital Revenue Code	250
Min. Negotiated Rate	$45.63
Max. Negotiated Rate	$70.20
Rate for Payer: Aetna Commercial	$63.18
Rate for Payer: ASR ASR	$68.09
Rate for Payer: ASR Commercial	$68.09
Rate for Payer: BCBS Trust/PPO	$57.21
Rate for Payer: BCN Commercial	$54.43
Rate for Payer: Cash Price	$56.16
Rate for Payer: Cofinity Commercial	$65.99
Rate for Payer: Encore Health Key Benefits Commercial	$56.16
Rate for Payer: Healthscope Commercial	$70.20
Rate for Payer: Healthscope Whirlpool	$68.09
Rate for Payer: Mclaren Commercial	$63.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$59.67
Rate for Payer: Nomi Health Commercial	$57.56
Rate for Payer: Priority Health Cigna Priority Health	$45.63
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$61.78

KETAMINE 10 MG/ML INJECTION IV (CODE)

Facility

$53.50

Service Code	NDC 42023011310
Hospital Charge Code	163727
Hospital Revenue Code	250
Min. Negotiated Rate	$21.40
Max. Negotiated Rate	$53.50
Rate for Payer: Aetna Commercial	$48.15
Rate for Payer: Aetna Medicare	$26.75
Rate for Payer: ASR ASR	$51.90
Rate for Payer: ASR Commercial	$51.90
Rate for Payer: BCBS Complete	$21.40
Rate for Payer: BCBS Trust/PPO	$43.81
Rate for Payer: BCN Commercial	$41.48
Rate for Payer: Cash Price	$42.80
Rate for Payer: Cofinity Commercial	$50.29
Rate for Payer: Encore Health Key Benefits Commercial	$42.80
Rate for Payer: Healthscope Commercial	$53.50
Rate for Payer: Healthscope Whirlpool	$51.90
Rate for Payer: Mclaren Commercial	$48.15
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$45.48
Rate for Payer: Nomi Health Commercial	$43.87
Rate for Payer: Priority Health Cigna Priority Health	$34.78
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$46.88
Rate for Payer: Priority Health Narrow Network	$37.50
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$47.08

KETAMINE 10 MG/ML INJECTION IV (CODE)

Facility

$70.20

Service Code	NDC 67457018100
Hospital Charge Code	163727
Hospital Revenue Code	250
Min. Negotiated Rate	$28.08
Max. Negotiated Rate	$70.20
Rate for Payer: Aetna Commercial	$63.18
Rate for Payer: Aetna Medicare	$35.10
Rate for Payer: ASR ASR	$68.09
Rate for Payer: ASR Commercial	$68.09
Rate for Payer: BCBS Complete	$28.08
Rate for Payer: BCBS Trust/PPO	$57.49
Rate for Payer: BCN Commercial	$54.43
Rate for Payer: Cash Price	$56.16
Rate for Payer: Cofinity Commercial	$65.99
Rate for Payer: Encore Health Key Benefits Commercial	$56.16
Rate for Payer: Healthscope Commercial	$70.20
Rate for Payer: Healthscope Whirlpool	$68.09
Rate for Payer: Mclaren Commercial	$63.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$59.67
Rate for Payer: Nomi Health Commercial	$57.56
Rate for Payer: Priority Health Cigna Priority Health	$45.63
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$61.51
Rate for Payer: Priority Health Narrow Network	$49.21
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$61.78

KETAMINE 10 MG/ML INJECTION IV (CODE)

Facility

$20.46

Service Code	NDC 09900001060
Hospital Charge Code	163727
Hospital Revenue Code	250
Min. Negotiated Rate	$13.30
Max. Negotiated Rate	$20.46
Rate for Payer: Aetna Commercial	$18.41
Rate for Payer: ASR ASR	$19.85
Rate for Payer: ASR Commercial	$19.85
Rate for Payer: BCBS Trust/PPO	$16.67
Rate for Payer: BCN Commercial	$15.86
Rate for Payer: Cash Price	$16.37
Rate for Payer: Cofinity Commercial	$19.23
Rate for Payer: Encore Health Key Benefits Commercial	$16.37
Rate for Payer: Healthscope Commercial	$20.46
Rate for Payer: Healthscope Whirlpool	$19.85
Rate for Payer: Mclaren Commercial	$18.41
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$17.39
Rate for Payer: Nomi Health Commercial	$16.78
Rate for Payer: Priority Health Cigna Priority Health	$13.30
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$18.00

KETAMINE 10 MG/ML INJECTION SOLUTION

Facility

$69.80

Service Code	NDC 55150043801
Hospital Charge Code	4236
Hospital Revenue Code	250
Min. Negotiated Rate	$27.92
Max. Negotiated Rate	$69.80
Rate for Payer: Aetna Commercial	$62.82
Rate for Payer: Aetna Medicare	$34.90
Rate for Payer: ASR ASR	$67.71
Rate for Payer: ASR Commercial	$67.71
Rate for Payer: BCBS Complete	$27.92
Rate for Payer: BCBS Trust/PPO	$57.16
Rate for Payer: BCN Commercial	$54.12
Rate for Payer: Cash Price	$55.84
Rate for Payer: Cofinity Commercial	$65.61
Rate for Payer: Encore Health Key Benefits Commercial	$55.84
Rate for Payer: Healthscope Commercial	$69.80
Rate for Payer: Healthscope Whirlpool	$67.71
Rate for Payer: Mclaren Commercial	$62.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$59.33
Rate for Payer: Nomi Health Commercial	$57.24
Rate for Payer: Priority Health Cigna Priority Health	$45.37
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$61.16
Rate for Payer: Priority Health Narrow Network	$48.93
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$61.42

KETAMINE 10 MG/ML INJECTION SOLUTION

Facility

$19.20

Service Code	NDC 09900000869
Hospital Charge Code	4236
Hospital Revenue Code	250
Min. Negotiated Rate	$12.48
Max. Negotiated Rate	$19.20
Rate for Payer: Aetna Commercial	$17.28
Rate for Payer: ASR ASR	$18.62
Rate for Payer: ASR Commercial	$18.62
Rate for Payer: BCBS Trust/PPO	$15.65
Rate for Payer: BCN Commercial	$14.89
Rate for Payer: Cash Price	$15.36
Rate for Payer: Cofinity Commercial	$18.05
Rate for Payer: Encore Health Key Benefits Commercial	$15.36
Rate for Payer: Healthscope Commercial	$19.20
Rate for Payer: Healthscope Whirlpool	$18.62
Rate for Payer: Mclaren Commercial	$17.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$16.32
Rate for Payer: Nomi Health Commercial	$15.74
Rate for Payer: Priority Health Cigna Priority Health	$12.48
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$16.90

KETAMINE 10 MG/ML INJECTION SOLUTION

Facility

$69.80

Service Code	NDC 55150043801
Hospital Charge Code	4236
Hospital Revenue Code	250
Min. Negotiated Rate	$45.37
Max. Negotiated Rate	$69.80
Rate for Payer: Aetna Commercial	$62.82
Rate for Payer: ASR ASR	$67.71
Rate for Payer: ASR Commercial	$67.71
Rate for Payer: BCBS Trust/PPO	$56.88
Rate for Payer: BCN Commercial	$54.12
Rate for Payer: Cash Price	$55.84
Rate for Payer: Cofinity Commercial	$65.61
Rate for Payer: Encore Health Key Benefits Commercial	$55.84
Rate for Payer: Healthscope Commercial	$69.80
Rate for Payer: Healthscope Whirlpool	$67.71
Rate for Payer: Mclaren Commercial	$62.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$59.33
Rate for Payer: Nomi Health Commercial	$57.24
Rate for Payer: Priority Health Cigna Priority Health	$45.37
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$61.42

KETAMINE 10 MG/ML INJECTION SOLUTION

Facility

$19.20

Service Code	NDC 09900000869
Hospital Charge Code	4236
Hospital Revenue Code	250
Min. Negotiated Rate	$7.68
Max. Negotiated Rate	$19.20
Rate for Payer: Aetna Commercial	$17.28
Rate for Payer: Aetna Medicare	$9.60
Rate for Payer: ASR ASR	$18.62
Rate for Payer: ASR Commercial	$18.62
Rate for Payer: BCBS Complete	$7.68
Rate for Payer: BCBS Trust/PPO	$15.72
Rate for Payer: BCN Commercial	$14.89
Rate for Payer: Cash Price	$15.36
Rate for Payer: Cofinity Commercial	$18.05
Rate for Payer: Encore Health Key Benefits Commercial	$15.36
Rate for Payer: Healthscope Commercial	$19.20
Rate for Payer: Healthscope Whirlpool	$18.62
Rate for Payer: Mclaren Commercial	$17.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$16.32
Rate for Payer: Nomi Health Commercial	$15.74
Rate for Payer: Priority Health Cigna Priority Health	$12.48
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$16.82
Rate for Payer: Priority Health Narrow Network	$13.46
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$16.90

KETAMINE 10 MG/ML INJECTION SOLUTION

Facility

$20.46

Service Code	NDC 09900001060
Hospital Charge Code	4236
Hospital Revenue Code	250
Min. Negotiated Rate	$8.18
Max. Negotiated Rate	$20.46
Rate for Payer: Aetna Commercial	$18.41
Rate for Payer: Aetna Medicare	$10.23
Rate for Payer: ASR ASR	$19.85
Rate for Payer: ASR Commercial	$19.85
Rate for Payer: BCBS Complete	$8.18
Rate for Payer: BCBS Trust/PPO	$16.75
Rate for Payer: BCN Commercial	$15.86
Rate for Payer: Cash Price	$16.37
Rate for Payer: Cofinity Commercial	$19.23
Rate for Payer: Encore Health Key Benefits Commercial	$16.37
Rate for Payer: Healthscope Commercial	$20.46
Rate for Payer: Healthscope Whirlpool	$19.85
Rate for Payer: Mclaren Commercial	$18.41
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$17.39
Rate for Payer: Nomi Health Commercial	$16.78
Rate for Payer: Priority Health Cigna Priority Health	$13.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$17.93
Rate for Payer: Priority Health Narrow Network	$14.34
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$18.00

KETAMINE 10 MG/ML INJECTION SOLUTION

Facility

$20.46

Service Code	NDC 09900001060
Hospital Charge Code	4236
Hospital Revenue Code	250
Min. Negotiated Rate	$13.30
Max. Negotiated Rate	$20.46
Rate for Payer: Aetna Commercial	$18.41
Rate for Payer: ASR ASR	$19.85
Rate for Payer: ASR Commercial	$19.85
Rate for Payer: BCBS Trust/PPO	$16.67
Rate for Payer: BCN Commercial	$15.86
Rate for Payer: Cash Price	$16.37
Rate for Payer: Cofinity Commercial	$19.23
Rate for Payer: Encore Health Key Benefits Commercial	$16.37
Rate for Payer: Healthscope Commercial	$20.46
Rate for Payer: Healthscope Whirlpool	$19.85
Rate for Payer: Mclaren Commercial	$18.41
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$17.39
Rate for Payer: Nomi Health Commercial	$16.78
Rate for Payer: Priority Health Cigna Priority Health	$13.30
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$18.00

KETAMINE 10 MG/ML INJECTION SOLUTION

Facility

$69.80

Service Code	NDC 55150043810
Hospital Charge Code	4236
Hospital Revenue Code	250
Min. Negotiated Rate	$45.37
Max. Negotiated Rate	$69.80
Rate for Payer: Aetna Commercial	$62.82
Rate for Payer: ASR ASR	$67.71
Rate for Payer: ASR Commercial	$67.71
Rate for Payer: BCBS Trust/PPO	$56.88
Rate for Payer: BCN Commercial	$54.12
Rate for Payer: Cash Price	$55.84
Rate for Payer: Cofinity Commercial	$65.61
Rate for Payer: Encore Health Key Benefits Commercial	$55.84
Rate for Payer: Healthscope Commercial	$69.80
Rate for Payer: Healthscope Whirlpool	$67.71
Rate for Payer: Mclaren Commercial	$62.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$59.33
Rate for Payer: Nomi Health Commercial	$57.24
Rate for Payer: Priority Health Cigna Priority Health	$45.37
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$61.42

KETAMINE 10 MG/ML INJECTION SOLUTION

Facility

$69.80

Service Code	NDC 55150043810
Hospital Charge Code	4236
Hospital Revenue Code	250
Min. Negotiated Rate	$27.92
Max. Negotiated Rate	$69.80
Rate for Payer: Aetna Commercial	$62.82
Rate for Payer: Aetna Medicare	$34.90
Rate for Payer: ASR ASR	$67.71
Rate for Payer: ASR Commercial	$67.71
Rate for Payer: BCBS Complete	$27.92
Rate for Payer: BCBS Trust/PPO	$57.16
Rate for Payer: BCN Commercial	$54.12
Rate for Payer: Cash Price	$55.84
Rate for Payer: Cofinity Commercial	$65.61
Rate for Payer: Encore Health Key Benefits Commercial	$55.84
Rate for Payer: Healthscope Commercial	$69.80
Rate for Payer: Healthscope Whirlpool	$67.71
Rate for Payer: Mclaren Commercial	$62.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$59.33
Rate for Payer: Nomi Health Commercial	$57.24
Rate for Payer: Priority Health Cigna Priority Health	$45.37
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$61.16
Rate for Payer: Priority Health Narrow Network	$48.93
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$61.42

KETAMINE 50 MG/5 ML (10 MG/ML) IV SYRINGE

Facility

$32.20

Service Code	NDC 70092111944
Hospital Charge Code	118700
Hospital Revenue Code	250
Min. Negotiated Rate	$12.88
Max. Negotiated Rate	$32.20
Rate for Payer: Aetna Commercial	$28.98
Rate for Payer: Aetna Medicare	$16.10
Rate for Payer: ASR ASR	$31.23
Rate for Payer: ASR Commercial	$31.23
Rate for Payer: BCBS Complete	$12.88
Rate for Payer: BCBS Trust/PPO	$26.37
Rate for Payer: BCN Commercial	$24.96
Rate for Payer: Cash Price	$25.76
Rate for Payer: Cofinity Commercial	$30.27
Rate for Payer: Encore Health Key Benefits Commercial	$25.76
Rate for Payer: Healthscope Commercial	$32.20
Rate for Payer: Healthscope Whirlpool	$31.23
Rate for Payer: Mclaren Commercial	$28.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$27.37
Rate for Payer: Nomi Health Commercial	$26.40
Rate for Payer: Priority Health Cigna Priority Health	$20.93
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$28.21
Rate for Payer: Priority Health Narrow Network	$22.57
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$28.34

KETAMINE 50 MG/5 ML (10 MG/ML) IV SYRINGE

Facility

$32.20

Service Code	NDC 70092111944
Hospital Charge Code	118700
Hospital Revenue Code	250
Min. Negotiated Rate	$20.93
Max. Negotiated Rate	$32.20
Rate for Payer: Aetna Commercial	$28.98
Rate for Payer: ASR ASR	$31.23
Rate for Payer: ASR Commercial	$31.23
Rate for Payer: BCBS Trust/PPO	$26.24
Rate for Payer: BCN Commercial	$24.96
Rate for Payer: Cash Price	$25.76
Rate for Payer: Cofinity Commercial	$30.27
Rate for Payer: Encore Health Key Benefits Commercial	$25.76
Rate for Payer: Healthscope Commercial	$32.20
Rate for Payer: Healthscope Whirlpool	$31.23
Rate for Payer: Mclaren Commercial	$28.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$27.37
Rate for Payer: Nomi Health Commercial	$26.40
Rate for Payer: Priority Health Cigna Priority Health	$20.93
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$28.34

KETAMINE 50 MG/ML INJECTION SOLUTION

Facility

$39.06

Service Code	NDC 00143950801
Hospital Charge Code	4238
Hospital Revenue Code	250
Min. Negotiated Rate	$25.39
Max. Negotiated Rate	$39.06
Rate for Payer: Aetna Commercial	$35.15
Rate for Payer: ASR ASR	$37.89
Rate for Payer: ASR Commercial	$37.89
Rate for Payer: BCBS Trust/PPO	$31.83
Rate for Payer: BCN Commercial	$30.28
Rate for Payer: Cash Price	$31.25
Rate for Payer: Cofinity Commercial	$36.72
Rate for Payer: Encore Health Key Benefits Commercial	$31.25
Rate for Payer: Healthscope Commercial	$39.06
Rate for Payer: Healthscope Whirlpool	$37.89
Rate for Payer: Mclaren Commercial	$35.15
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$33.20
Rate for Payer: Nomi Health Commercial	$32.03
Rate for Payer: Priority Health Cigna Priority Health	$25.39
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$34.37

KETAMINE 50 MG/ML INJECTION SOLUTION

Facility

$39.06

Service Code	NDC 00143950810
Hospital Charge Code	4238
Hospital Revenue Code	250
Min. Negotiated Rate	$15.62
Max. Negotiated Rate	$39.06
Rate for Payer: Aetna Commercial	$35.15
Rate for Payer: Aetna Medicare	$19.53
Rate for Payer: ASR ASR	$37.89
Rate for Payer: ASR Commercial	$37.89
Rate for Payer: BCBS Complete	$15.62
Rate for Payer: BCBS Trust/PPO	$31.99
Rate for Payer: BCN Commercial	$30.28
Rate for Payer: Cash Price	$31.25
Rate for Payer: Cofinity Commercial	$36.72
Rate for Payer: Encore Health Key Benefits Commercial	$31.25
Rate for Payer: Healthscope Commercial	$39.06
Rate for Payer: Healthscope Whirlpool	$37.89
Rate for Payer: Mclaren Commercial	$35.15
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$33.20
Rate for Payer: Nomi Health Commercial	$32.03
Rate for Payer: Priority Health Cigna Priority Health	$25.39
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$34.22
Rate for Payer: Priority Health Narrow Network	$27.38
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$34.37

KETAMINE 50 MG/ML INJECTION SOLUTION

Facility

$39.06

Service Code	NDC 00143950801
Hospital Charge Code	4238
Hospital Revenue Code	250
Min. Negotiated Rate	$15.62
Max. Negotiated Rate	$39.06
Rate for Payer: Aetna Commercial	$35.15
Rate for Payer: Aetna Medicare	$19.53
Rate for Payer: ASR ASR	$37.89
Rate for Payer: ASR Commercial	$37.89
Rate for Payer: BCBS Complete	$15.62
Rate for Payer: BCBS Trust/PPO	$31.99
Rate for Payer: BCN Commercial	$30.28
Rate for Payer: Cash Price	$31.25
Rate for Payer: Cofinity Commercial	$36.72
Rate for Payer: Encore Health Key Benefits Commercial	$31.25
Rate for Payer: Healthscope Commercial	$39.06
Rate for Payer: Healthscope Whirlpool	$37.89
Rate for Payer: Mclaren Commercial	$35.15
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$33.20
Rate for Payer: Nomi Health Commercial	$32.03
Rate for Payer: Priority Health Cigna Priority Health	$25.39
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$34.22
Rate for Payer: Priority Health Narrow Network	$27.38
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$34.37

KETAMINE 50 MG/ML INJECTION SOLUTION

Facility

$39.06

Service Code	NDC 00143950810
Hospital Charge Code	4238
Hospital Revenue Code	250
Min. Negotiated Rate	$25.39
Max. Negotiated Rate	$39.06
Rate for Payer: Aetna Commercial	$35.15
Rate for Payer: ASR ASR	$37.89
Rate for Payer: ASR Commercial	$37.89
Rate for Payer: BCBS Trust/PPO	$31.83
Rate for Payer: BCN Commercial	$30.28
Rate for Payer: Cash Price	$31.25
Rate for Payer: Cofinity Commercial	$36.72
Rate for Payer: Encore Health Key Benefits Commercial	$31.25
Rate for Payer: Healthscope Commercial	$39.06
Rate for Payer: Healthscope Whirlpool	$37.89
Rate for Payer: Mclaren Commercial	$35.15
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$33.20
Rate for Payer: Nomi Health Commercial	$32.03
Rate for Payer: Priority Health Cigna Priority Health	$25.39
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$34.37

KETOCONAZOLE 2 % TOPICAL CREAM

Facility

$45.99

Service Code	NDC 00168009930
Hospital Charge Code	10368
Hospital Revenue Code	637
Min. Negotiated Rate	$18.40
Max. Negotiated Rate	$45.99
Rate for Payer: Aetna Commercial	$41.39
Rate for Payer: Aetna Medicare	$23.00
Rate for Payer: ASR ASR	$44.61
Rate for Payer: ASR Commercial	$44.61
Rate for Payer: BCBS Complete	$18.40
Rate for Payer: BCBS Trust/PPO	$37.66
Rate for Payer: BCN Commercial	$35.66
Rate for Payer: Cash Price	$36.79
Rate for Payer: Cofinity Commercial	$43.23
Rate for Payer: Encore Health Key Benefits Commercial	$36.79
Rate for Payer: Healthscope Commercial	$45.99
Rate for Payer: Healthscope Whirlpool	$44.61
Rate for Payer: Mclaren Commercial	$41.39
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$39.09
Rate for Payer: Nomi Health Commercial	$37.71
Rate for Payer: Priority Health Cigna Priority Health	$29.89
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$40.30
Rate for Payer: Priority Health Narrow Network	$32.24
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$40.47

KETOCONAZOLE 2 % TOPICAL CREAM

Facility

$45.99

Service Code	NDC 00168009930
Hospital Charge Code	10368
Hospital Revenue Code	637
Min. Negotiated Rate	$29.89
Max. Negotiated Rate	$45.99
Rate for Payer: Aetna Commercial	$41.39
Rate for Payer: ASR ASR	$44.61
Rate for Payer: ASR Commercial	$44.61
Rate for Payer: BCBS Trust/PPO	$37.48
Rate for Payer: BCN Commercial	$35.66
Rate for Payer: Cash Price	$36.79
Rate for Payer: Cofinity Commercial	$43.23
Rate for Payer: Encore Health Key Benefits Commercial	$36.79
Rate for Payer: Healthscope Commercial	$45.99
Rate for Payer: Healthscope Whirlpool	$44.61
Rate for Payer: Mclaren Commercial	$41.39
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$39.09
Rate for Payer: Nomi Health Commercial	$37.71
Rate for Payer: Priority Health Cigna Priority Health	$29.89
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$40.47

KETOROLAC 0.5 % EYE DROPS

Facility

$26.37

Service Code	NDC 41616021990
Hospital Charge Code	19733
Hospital Revenue Code	637
Min. Negotiated Rate	$17.14
Max. Negotiated Rate	$26.37
Rate for Payer: Aetna Commercial	$23.73
Rate for Payer: ASR ASR	$25.58
Rate for Payer: ASR Commercial	$25.58
Rate for Payer: BCBS Trust/PPO	$21.49
Rate for Payer: BCN Commercial	$20.44
Rate for Payer: Cash Price	$21.09
Rate for Payer: Cofinity Commercial	$24.79
Rate for Payer: Encore Health Key Benefits Commercial	$21.10
Rate for Payer: Healthscope Commercial	$26.37
Rate for Payer: Healthscope Whirlpool	$25.58
Rate for Payer: Mclaren Commercial	$23.73
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$22.41
Rate for Payer: Nomi Health Commercial	$21.62
Rate for Payer: Priority Health Cigna Priority Health	$17.14
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$23.21

KETOROLAC 0.5 % EYE DROPS

Facility

$104.37

Service Code	NDC 60505100301
Hospital Charge Code	19733
Hospital Revenue Code	637
Min. Negotiated Rate	$67.84
Max. Negotiated Rate	$104.37
Rate for Payer: Aetna Commercial	$93.93
Rate for Payer: ASR ASR	$101.24
Rate for Payer: ASR Commercial	$101.24
Rate for Payer: BCBS Trust/PPO	$85.05
Rate for Payer: BCN Commercial	$80.92
Rate for Payer: Cash Price	$83.50
Rate for Payer: Cofinity Commercial	$98.11
Rate for Payer: Encore Health Key Benefits Commercial	$83.50
Rate for Payer: Healthscope Commercial	$104.37
Rate for Payer: Healthscope Whirlpool	$101.24
Rate for Payer: Mclaren Commercial	$93.93
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$88.71
Rate for Payer: Nomi Health Commercial	$85.58
Rate for Payer: Priority Health Cigna Priority Health	$67.84
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$91.85

KETOROLAC 0.5 % EYE DROPS

Facility

$104.83

Service Code	NDC 17478020910
Hospital Charge Code	19733
Hospital Revenue Code	637
Min. Negotiated Rate	$68.14
Max. Negotiated Rate	$104.83
Rate for Payer: Aetna Commercial	$94.35
Rate for Payer: ASR ASR	$101.69
Rate for Payer: ASR Commercial	$101.69
Rate for Payer: BCBS Trust/PPO	$85.43
Rate for Payer: BCN Commercial	$81.27
Rate for Payer: Cash Price	$83.86
Rate for Payer: Cofinity Commercial	$98.54
Rate for Payer: Encore Health Key Benefits Commercial	$83.86
Rate for Payer: Healthscope Commercial	$104.83
Rate for Payer: Healthscope Whirlpool	$101.69
Rate for Payer: Mclaren Commercial	$94.35
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$89.11
Rate for Payer: Nomi Health Commercial	$85.96
Rate for Payer: Priority Health Cigna Priority Health	$68.14
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$92.25

KETOROLAC 0.5 % EYE DROPS

Facility

$26.37

Service Code	NDC 41616021990
Hospital Charge Code	19733
Hospital Revenue Code	637
Min. Negotiated Rate	$10.55
Max. Negotiated Rate	$26.37
Rate for Payer: Aetna Commercial	$23.73
Rate for Payer: Aetna Medicare	$13.18
Rate for Payer: ASR ASR	$25.58
Rate for Payer: ASR Commercial	$25.58
Rate for Payer: BCBS Complete	$10.55
Rate for Payer: BCBS Trust/PPO	$21.59
Rate for Payer: BCN Commercial	$20.44
Rate for Payer: Cash Price	$21.09
Rate for Payer: Cofinity Commercial	$24.79
Rate for Payer: Encore Health Key Benefits Commercial	$21.10
Rate for Payer: Healthscope Commercial	$26.37
Rate for Payer: Healthscope Whirlpool	$25.58
Rate for Payer: Mclaren Commercial	$23.73
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$22.41
Rate for Payer: Nomi Health Commercial	$21.62
Rate for Payer: Priority Health Cigna Priority Health	$17.14
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$23.11
Rate for Payer: Priority Health Narrow Network	$18.49
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$23.21

KETOROLAC 0.5 % EYE DROPS

Facility

$47.85

Service Code	NDC 17478020919
Hospital Charge Code	19733
Hospital Revenue Code	637
Min. Negotiated Rate	$31.10
Max. Negotiated Rate	$47.85
Rate for Payer: Aetna Commercial	$43.06
Rate for Payer: ASR ASR	$46.41
Rate for Payer: ASR Commercial	$46.41
Rate for Payer: BCBS Trust/PPO	$38.99
Rate for Payer: BCN Commercial	$37.10
Rate for Payer: Cash Price	$38.28
Rate for Payer: Cofinity Commercial	$44.98
Rate for Payer: Encore Health Key Benefits Commercial	$38.28
Rate for Payer: Healthscope Commercial	$47.85
Rate for Payer: Healthscope Whirlpool	$46.41
Rate for Payer: Mclaren Commercial	$43.06
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$40.67
Rate for Payer: Nomi Health Commercial	$39.24
Rate for Payer: Priority Health Cigna Priority Health	$31.10
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$42.11

Know your out-of-pocket cost for care.

All Charges